Treatment of TMJ ankylosis poses many risks and complexities beyond routine TMJ surgery. These risks include bleeding from a unaccessable artery, damage to adjacent structures such as intracranial, middle ear, and the infratemporal fossa. Our protocol includes preoperative planning with CT angiography and medical modeling, selective ebolization of branches of the external carotid system either preoperative or intraoperative with surgical exposure of the external carotid artery branches and surgical navigation (Brain Lab). This protocol has been used on 13 patients with TMJ ankylosis. All patients have been treated successfully with this protocol, and have not had any complications either intraoperatively or postoperatively. Following the initial surgery a spacer was placed and a stage two total joint prosthesis was placed.
Conflict of interest: I have received royalties from a TMJ prosthesis used in some of the patients.